UTERINE ARTERY BLOOD-FLOW VELOCITY WAVE-FORMS IN PREGNANT-WOMEN WITH MULLERIAN DUCT ANOMALY - A BIOLOGIC MODEL FOR UTEROPLACENTAL INSUFFICIENCY

OBJECTIVE: The purpose of this lady was to determine whether there are demonstrable alterations in uterine artery blood flow in pregnant wom en with mullerian duct anomaly STUDY DESIGN: Flow velocity waveforms o btained from the placental and non placental uterine arteries were stu died at 18 to 24 weeks' gestational age in 15 pregnant women with mull erian duct anomaly and in 30 controls. The systolic/diastolic ratios w ere compared and correlated with the degree of placental laterality an d perinatal outcome. RESULTS: Systolic/diastolic ratio in the uterine artery was abnormal in 80% of the cases and in 10% of controls (p < 0. 0001). A completely lateral placenta was found in 10 of 15 women of th e study group and only in 1 of the 30;controls (p < 0.0001). Women wit h mullerian duct anomaly had higher systolic/diastolic ratios in the n onplacental uterine artery than those with a normal uterus (median 4.3 , range 2.0 to 7.4 vs median 2.8, range 2.0 to 4.0; p < 0.001). Twelve of 15 women of the study group had poor perinatal outcome compared wi th 4 of the 30 controls (p < 0.001). Among those women with poor perin atal outcome, II of 12 (92%) in the study group and only 1 of the 4 (2 5%) in the control group had an abnormal systolic/diastolic ratio in t he uterine arteries (p < 0.05).CONCLUSION: There is a clear associatio n between placental laterality and high systolic/diastolic ratio in th e nonplacental uterine artery in pregnant women with mullerian duct an omaly who had poor perinatal outcome. This finding suggests that unila teral placental implantation could lead to functional exclusion of one uterine artery from the uteroplacental circulation and could explain pregnancy complications in women with developmental fusion defects of the uterus.